Nutrition assessment and support of organ transplant recipients.

Timely nutrition assessment and intervention in organ transplant recipients may improve outcomes surrounding transplantation. A pretransplant nutrition assessment should include a variety of parameters including physical assessment, history, anthropometric measurements, and laboratory tests. Malnutrition compromises posttransplant survival; prolonged waiting times worsen outcomes when patients are already malnourished. Severe obesity may decrease graft function and survival in kidney transplant recipients. In the pretransplant phase, nutritional goals include optimization of nutritional status and treatment of nutrition-related symptoms induced by organ failure. Enteral tube feeding is indicated for patients with functional gastrointestinal tracts who are not eating adequately. Parenteral nutrition is rarely needed pretransplant except in cases of intestinal failure. When determining pretransplant nutrient requirements, nutritional status, weight, age, gender, metabolic state, stage and type of organ failure, malabsorption, induced losses, goals, and comorbid conditions must be considered. During the acute posttransplant phase, adequate nutrition is required to help prevent infection, promote wound healing, support metabolic demands, replenish lost stores, and perhaps mediate the immune response. Nutrient recommendations reflect posttransplant metabolic changes. The appropriateness of posttransplant nutrition support depends on the prevalence of malnutrition among patients with a specific type of organ failure and the benefits when nutrition support is given. Organ transplantation complications including rejection, infection, wound healing, renal insufficiency, hyperglycemia, and surgical complications require specific nutritional requirements and therapies. Many potential applications of nutrition in the pre- and posttransplant phases exist and require further study.

Evaluacion y soporte nutricional de los pacientes de trasplante de organos / Nutritional Assessment and support in transplantation case

La evaluación nutricional oportuna y la intervención en pacientes trasplantados pueden mejorar tos resultados del trasplante. La evaluación de la nutrición previa al trasplante debe incluir una variedad de parámetros que incluyan: una evaluación física, la historia, mediciones antropométricas y pruebas de laboratorio. La desnutrición compromete la supervivencia posterior al trasplante. La obesidad severa puede reducir la función del injerto y la supervivencia de los pacientes de trasplante de riñon. En la fase previa al trasplante, los objetivos nutricionales incluyen la optimización del estado nutricional y el tratamiento de los síntomas relacionados con la nutrición, inducidos por la falla del organo

Diet therapy for organ transplantation. A problem-based approach.

Nutrition plays a vital role in the recovery, health, and life expectancy of transplant recipients. Because the medical problems differ between the acute recovery and chronic maintenance phases following transplantation, nutrient requirements and nutrition therapies are unique and distinctly different between these 2 periods. Nutrition therapy during the acute post-transplant phase is aimed at promoting healing. Nutrition and pharmaceutical therapies during the long-term post-transplant phase are intended to prevent and treat common problems such as obesity, diabetes, hyperlipidemia, hypertension, and osteoporosis. Nutrition goals and therapies should be individualized based on the specific complications each patient experiences.

Early enteral nutrition support in patients undergoing liver transplantation.

BACKGROUND: The purpose of this study was to determine the effects of early postoperative tube feeding on outcomes of liver transplant recipients. METHODS: Fifty transplant patients were randomized prospectively to receive enteral formula via nasointestinal feeding tubes (tube-feeding [TF] group) or maintenance i.v. fluid until oral diets were initiated (control group). Thirty-one patients completed the study. Resting energy expenditure, nitrogen balance, and grip strength were measured on days 2, 4, 7, and 12 after liver transplantation. Calorie and protein intakes were calculated for 12 days posttransplant. RESULTS: Tube feeding was tolerated in the TF group (n = 14). The TF patients had greater cumulative 12-day nutrient intakes (22,464 +/- 3554 kcal, 927 +/- 122 g protein) than did the control patients (15,474 +/- 5265 kcal, 637 +/- 248 g protein) (p < .002). Nitrogen balance was better in the TF group on posttransplant day 4 than in the control group (p < .03). There was a rise in the overall mean resting energy expenditure in the first two posttransplant weeks from 1487 +/- 338 to 1990 +/- 367 kcal (p = .0002). Viral infections occurred in 17.7% of control patients compared with 0% of TF patients (p = .05). Although other infections tended to occur more frequently in the control group vs the TF group (bacterial, 29.4% vs 14.3%; overall infections, 47.1% vs 21.4%), these differences were not statistically significant. Early posttransplant tube feeding did not influence hospitalization costs, hours on the ventilator, lengths of stay in the intensive care unit and hospital, rehospitalizations, or rejection during the first 21 posttransplant days. CONCLUSIONS: Early posttransplant tube feeding was tolerated and promoted improvements in some outcomes and should be considered for all liver transplant patients.

Nutritional implications of liver transplantation.

Malnutrition is a common problem of patients undergoing liver transplantation. To treat malnutrition, it must first be identified through a nutritional assessment. Because many objective nutritional assessment parameters have limitations in end-stage liver disease, subjective nutritional indicators may be used as an alternative. Nutritional needs following transplantation are categorized as short and long term. The short-term nutritional goal, anabolism, can be complicated by the nutritional status of the patient, surgical procedures, and necessary medications. The increased nutrient needs during the early posttransplant phase require particular nutritional support. Nutrition-related problems following transplantation may include obesity, hyperlipidemia, hypertension, diabetes mellitus, hyperkalemia, edema, or osteoporosis. Dietetic advice relative to the nutritional needs of the liver transplant recipient can improve both the short- and long-term outcomes.